MEDICAL REMINISCENSES A CALL UPON ROBERT KOCH IN HIS LABORATORY IN 1902. By EDWARD R. BALDWIN, M.D. EDITORIAL NOTE The accompanying article is the first of a series of medical reminiscences by Dr. Baldwin, following somewhat along the line of the series recently concluded by Dr. Vincent Y. Bowditch, (See April, May and July, 1919 numbers). The present article is the first of several dealing with Dr. Baldwin's experiences in Germany during the year 1902. The prestige of German medical science was possibly at its height twenty years ago. Certainly in the subject of tuberculosis, its sanatorium care and experimental investigation, that country had attracted more students than any other. Robert Koch was still active in his researches of tuberculin, which had been a source of keen chagrin to him by its failure to accomplish what he had confidently hoped for it. Prof. von Behring was at that time experimenting with methods of protecting calves from tuberculosis by vaccination. Sanatoria were being multiplied and supported by public funds on a large scale. In all these respects Germany offered much of interest to the student in tuberculosis, especially in the field of laboratory study. The writer had the privilege of visiting Germany eighteen years ago, with the hope of learning something of the progress and methods employed in the sanatoria. Fortunately, an introduction to Prof. Rabinowitsch, a Russian bacteriologist working in the Koch Institute, made it possible for me to meet Prof. Koch himself. No doubt he was annoyed and interrupted by my intrusion upon his time, but I was, in truth, "lion hunting" and the way was paved by my letter. The Institute was a very substantial and modern building of several stories. I climbed to the third to find Prof. Rabinowitsch, the delicate little Russian woman who herself has contributed much to tuberculosis research. She greeted me pleasantly and without ado said she would send for Prof. Koch, who was downstairs. I protested at such an imposition upon the Geheimrath Koch as to request him to climb a staircase to see an American stripling, but with characteristic directness of action she sent a "diener" or assistant, to call him. I was mortified, and when he shortly appeared, stumbled into an apology with what little German I could command for the occasion. He was a very quiet, white-haired man, without indications in his face of either pleasure or disgust at my visit. Behind large spectacles, he was the typical plodding Ger man, with little formality—but only formal to strangers who caused him to climb two flights of stairs at the behest of a slight, black-eyed, and determined Russian woman! After my explosion of my pigeon-EnglishGerman (which must have secretly amused him) he responded: "You need not speak in German; I speak English." This was a relief, even though his English was Germanized. Then he said, quite without impatience: "What would you wish here to do?" Only to ask him a few questions about tuberculin, and to have one of his assistants show me something about the tuberculosis experiments. "I will atke you to Dr. Neufeld, my assistant," said he calmly, and in halting words. On the way as we walked downstairs he stated that he considered tuberculin still the best treatment for tuberculosis, and that the latest tuberculin contained no living germs, as it was sterilized by glycerin. (The last remark was excited by my question on this point, as we had found living bacilli in some of the tuberculin residue from Germany.) He could absolutely assure me that the new tuberculin was sterilized by twenty days' contact with glycerin. Then he turned to another subject and became quite animated, I thought for such a phlegmatic man. I mentioned a certain New York doctor purporting to be "Dr. Koch" had exploited himself and had an "institute" in which he gave a "cure" for tuberculosis. "He is ein Schwindler! How can I him stop?" said he with some heat. I assured him that few people were deceived; that if the man was actually using his name the German embassy could protect him. Ignorant people only suffered, and we were doing all we could to denounce the trick. I called to his attention that the quacks lived by advertising, and had only a brief career in most cases. He was not fully satisfied, I fear, that America was not a home of "schwindlers." For a truth, I almost feared he suspected me as one disguised as a visitor! After a few other questions on minor points, partly answered in German, I was politely introduced to Dr. Neufeld, a young man of delicate build who was engaged in some experiments in Koch's private laboratory rooms. He was a serious worker and very polite. Prof. Koch thereupon left me as impressively as he had greeted me, my profuse thanks being accepted with a simple nod. All the assistants in a Berlin hospital or laboratory in those days greeted and parted from a visitor with a military bow, known to American students as the "jackknife." It is the peculiar heel-clickingstiff-back-bow from the hips. Dr. Neufeld freely showed me cultures of tubercle bacilli, serum tests for agglutinating bacilli, and in general was most entertaining to one engaged in similar studies. He finally conducted me to other departments in the In stitute where some Americans were working, and left me with them. I can truly say that my reception was very courteous and my interview with Koch entirely satisfactory. As it was generally known that Koch was not a man given to cultivating the social graces, I felt that he had been actually cordial to me. One must be flattered to have had Robert Koch speak English to him! Like other discoverers, he was the object of much criticism and jealousy. It is but natural that he should have become suspicious. Painstaking and thorough by instinct, Koch was a worker rather than a leader of men. This would be the impression a casual visitor would readily receive. I found him without a trace of self-importance, and retain the memory only of a matter-of-fact man without pose or sign of condescension. A PASSIONATE PILGRIM TO HIS BUG By J. F. O'NEILL, Mount McGregor, New York EDITORIAL NOTE The accompanying article by Mr. Luhn, Director of the Bureau of Correspondence and Information of the State Tuberculosis Sanatorium at Carlsbad, Texas, is a frank talk by a tuberculosis patient to tuberculosis patients. Mr. Luhn gives in this article some helpful and practical advice to those who are leaving the sanatorium or who are taking up the cure after an arrest or recovery at home. The JOURNAL OF THE OUTDOOR LIFE is planning to publish during the year a number of articles bearing upon this general subject of aftercare, employment, vocational training, etc. Each one will be full of practical suggestions and each one will be by someone who knows what he is talking about. SOME PROBLEMS CONFRONTING THE SANATORIUM PATIENT AFTER DISCHARGE By R. E. LUHN, JR., TEXAS STATE TUBERCULOSIS SANATORIUM A problem of utmost importance to the discharged sanatorium patient, able to work at all, is employment. The every-day question of how one may make a living, or employ oneself so as to be contented and useful to society, and yet maintain the ground gained during the stay in the sanatorium, is a very pressing one and needs to be given anxious, thoughtful consideration. The period of time spent in a sanatorium is usually, and rightfully, regarded as a period of preparation or of reeducation, to enable the tuberculosis individual to resume work, and continue to work, with the least possible injury to himself and to those surrounding him. It is true that the six or nine months' stay in the sanatorium may result, and usually does result, in great improvement in health to the individual but, as you well know, the classification used in defining the condition of a tuberculosis patient precludes the possibility of anyone being termed an arrested or "cured" case on discharge. Only a few can afford to remain in an institution, or even to receive treatment from a specialist, over a period of time sufficiently long to obtain an "arrest." For the many it is a problem of receiving as much benefit as possible from the limited sanatorium stay, with a return to work within a short time after discharge. The person really in earnest will endeavor to obtain maximum results during the sanatorium period and after discharge will continue to practice, to the best of his ability, what was taught him there. Such a person follows the doctors' and nurses' instructions to the letter. During the rest period he is actually resting, not hatching some devilment, or worrying over troubles, real or imaginary. All disturbing thoughts are banished from his mind. His body is thus freed from the troubles that are apt to result when the mind is ill at ease. I recently read an article by a physician famous in tuberculosis work in which he advised patients who were really compelled to worry to select one hour each day for the “blues," calling it the "Blue Hour," devoting the rest of their time to the business of getting well. The amount of exercise ordered and no more, is taken. In short, having placed himself under the care of specialists on tuberculosis, during the period of his stay in the sanatorium, the patient who is in earnest makes every effort to obtain full return from their treatment and also fully observes the rights of others. He is a constructionist and not an obstructionist. Having derived as much benefit as possible from his sanatorium stay, which stay, after all, is but an incident in his life and having resolved, let us hope, to continue practicing the rules of health that he has learned, the ex-patient is ready to tackle the real problem confronting him, that of obtaining remunerative employment. It must be also employment that will permit him finally to be classed as an arrested case of tuberculosis, or if this is impossible of attainment, at any rate allow him to retain a modicum of good health and be an economic asset to society. Some have the problem solved beforehand. Such will return to their homes with the duties of the housewife or, of the mother before themduties that are as important as any and that in nearly all instances can be regulated to meet the requirements of one's individual strength. Still others will return to positions held open for them by employers who will be considerate enough to make due allowances for their impaired physical condition-others will be compelled to seek a new occupation. A very helpful book, which I can heartily recommend for your reading, is "A Textbook of Crafts for Handicapped Workers."* The directions given in this book are elaborate and detailed and cover vocations such as "Handicrafts for the Handicapped," by Hall & See advertisement on page Bark. basketry, chair seating, netting, weaving, bookbinding, cement working, pottery making and light blacksmithing. In the appendix is given a list of books on crafts and dealers in craft work supplies. This book, which will be found in most libraries, should be especially helpful to those who have never worked and who are untrained in any line, because the problem of selecting an occupation in such cases is a difficult and complex one. The tuberculous person who has worked in some capacity or other, at least has passed through that period of preparation-of finding out in a general way what is required of him from employer and fellow workers. A fact to be faced is that there exists a common fear of tuberculosis. This fear has been very properly named "pthisiophobia" or consumption madness; nevertheless it is a factor to be reckoned with in seeking employment. Undoubtedly, if the employer does not know beforehand that one has had tuberculosis, it would be the part of wisdom to go to him after securing the position and tell him frankly everything concerning one's past and probable future condition. Quite often in this way the employer's sympathy and help can be secured at the very start, whereas if the fact that one has been an inmate of a sanatorium comes to light at a later date, loss of confidence, or even loss of place itself, may result. Circumstances alter cases and no hard and fast rule can be set down. With fellow employees it is a question whether or not mention should be made of one's past history. Where several are employed it can be depended on that there will always be one or more to whom no satisfactory explanation of the non-danger of contact can be made. In my opinion, as public opinion exists today, as long as one's employer is fully informed of the situation, it will be found more satisfactory not to take others into one's confidence. Office work offers wonderful opportunities to the tuberculous person. To begin with, the period of training necessary to make an efficient stenographer or bookkeeper is comparatively short. Six months is sufficient time for a stenographic or bookkeeping course. Eight to twelve months is usually required for the combined course. The cost of obtaining this training is small. Scholarships in the single course may be obtained at reputable business colleges for $50.00 to $75.00-in the combined course for $75.00 to $100.00. Board, and good board at that, with room, can be obtained for $25.00 to $35.00 per month in many places. These figures apply to this state only, as I am not familiar with conditions applying in other states. Courses in business colleges are usually paid for outright, with no time limit, or if there is a time limit, a very reasonable one, set for their completion. This, of course, favors the person who is barred from devoting long hours to intensive study. 7:00 A. M.-Arise. 8:00 A. M.-12:00 M.-Office. 12:00 M.-1:00 P. M.-Luncheon, with short rest period. 1:00 P. M.-5:00 P. M.-Office. 5:00 P. M.-6:30 P. M.-Relaxation. 6:30 P. M.-7:00 P. M.-Dinner. 7:00 P. M.-9:00 P. M.-Amusement or relaxation. 9:00 P. M.-7:00 A. M.-Bed. It would be well to adopt some such schedule, whether you work in office, shop or store, allowing of no side-stepping, no depending on making up lost sleep or rest on Sundays. Sunday's extra rest will be needed as much as any. If you set 9:00 P. M. as the hour for retiring, do not go to bed at 9:15 or 9:30 five nights out of the week, expecting to make up the lost time on Sundays. Other occupations besides office work offer opportunities to the tuberculous. Commercial traveling has been followed successfully by a few ex-patients of my acquaintance, but constant change, putting up with poor accommodations, mental strain involved in securing orders; all are serious offsets to the hours of freedom, which traveling men in some lines enjoy. In farming and ranching there are great possibilities. Many large farms and ranches make use of overseers, who are required to do little or no manual labor. One with some capital may get hold of a small farm or ranch and have all necessary labor done by hired help. Truck farming also offers possibilities in this direction. For one inexperienced in this line of work however, and with limited capital, to undertake anything of this kind is, in my opinion, suicidal. Telegraphy, for men, telephone operating for women, are occupations easily learned and fairly remunerative. Eight hours are usually observed in these occupations. I might mention any number of trades or occupations similar to the above if time would permit. A number of pamphlets gotten out by the Federal Board of Vocational Education are available to those interested and may be had on application at the office of the Board, Washington, D. C. These, of course, were published for the benefit of disabled soldiers, sailors and marines, but may prove helpful to some of you. I Numbers of cases of successful return to work by ex-patients present themselves to my mind. I will mention only one or two. recall one in particular of a real sick patient who returned to a department store, making arrangements to rest until 2:30 of afternoons, who not only has done exceptionally well, so far as his health is concerned, but has been put in charge of his department. He is well paid and his services are highly valued by his employer. Another patient, a printer and publisher of a small-town paper, entered the sanatorium a very sick man indeed. I remember his telling me about his high pulse rate and loss of weight. The former was 120 and he was forty or fifty pounds under-weight. He remained at the sanatorium nine months, securing an "apparent arrest." After discharge he sold his paper and obtained employment with a stationery house as road salesman, securing territory that involved no travelling by night and few long journeys. That was three years ago. I saw this man a short time since. He weighed 175 pounds, said he felt well all the time and was making $200.00 per month and expenses. He is an exceptionally conservative man, one who takes no chances. He is what I would term a successful "exlunger." The tuberculous person desirous of earning his own living must look to the three C'scourage, common sense and confidence. Courage is needed to continue the fight against odds; common sense that the peculiar problems confronted may be handled in a matter-of-fact way; and confidence not only to look out for one's own welfare but to give good service to one's employer. The ex-patient who has these three need have no fear of following any occupation in which no excessive mental strain, overwork or poor working conditions are involved. Now, may I be permitted to say a word about the part to be played by ex-patients who have returned to work with regard to their attitude to tuberculosis. It is for the individual to decide just how prominent his part will be in the fight against tuberculosis. The part played may be positive or negative. The patient leaving the sanatorium may speak a good word for the institution and for the work being undertaken or he may find plenty of opportunities for fault-finding, for belittling those responsible for the carrying on of the work. Whatever has been accomplished in the fight on tuberculosis has been done mainly by the tuberculous. The most successful physicians, nurses, and workers in the anti-tuberculosis game have either had the disease or have lost loved ones because of it. They have seen the Grim Reaper gather in his harvest from among their friends and relatives and having themselves escaped, because of having received proper instruction and treatment, they, in turn, largely through gratitude, desire to do what they can to better the situation. Especially have the sanatoria of the country, through their ex-patients, contributed to the sentiment which has made possible the grand fight now going on and which, let us hope, will be brought to a successful conclusion, if not in our time, at any rate in the next generation or two from ours. There are many, many ways in which one can aid in the fight, without interfering in the least with ordinary pursuits and with little or no drain on one's supply of nervous energy. The humblest have a certain amount of influence with those surrounding them; in fact, it is not always the one who puts on the most "front" whose advice is followed. A word of dissipating, a decided stand for better working caution to the person who is overworking or conditions, better housing, higher standards of living, health education and health inspection in the schools-such action, though the results may not be at once apparent, yet will steadily and surely bear wholesome fruit. It is not necessary to make oneself conspicuous by the public use of sputum cups, nor need one constantly advertise that he has been a patient in a sanatorium. I believe in absolute honesty along these lines. I believe that everyone who expectorates should use sputum cups but, at the present time there exists a popular prejudice against this use and one may observe a discretion about the matter suitable to the occasion. The good work of instructing others can be carried on quietly and yet be effectual. Names of people suspected of having tuberculosis can be submitted to the sanatorium and health authorities to receive pamphlets and leaflets. Occasionally the opportunity will present itself of delivering a heart to heart talk of advice and instruction to one badly in need of it. Finally, it has been my experience that work and worry will not mix with the tubercle bacilli, successfully. The bacillus seems to be a "choicy" sort. He chums very well with work alone, and to a certain extent can bear the company of worry, but seems to get angry when the two get together, with serious consequences, not to himself, but to his host. Just as the man who was drinking whiskey to such an extent that it was ruining his business was advised to give up business, so I would advise anyone with tuberculosis, as a choice between work and worry, to give up... work. UNSUBDUED I have hoped, I have planned, I have striven, I have prayed, but the gods would not heed. I have dared and reached only disaster, I am bruised by a pitiless master That the weak and the timid call chance. I feel old, I am bent, I am cheated LORNA DUHM. |